Abstract
Asthma is the most common cause of respiratory disability among children. Patients with severe bronchial asthma can experience cor pulmonale later in life, but little is known about the function of the right ventricle early in the disease. This study aimed to investigate the right ventricular function in children with bronchial asthma as detected by tissue Doppler echocardiography. This case-control study compared 60 asthmatic children ages 5 to 15 years between attacks (study group) with 60 apparently healthy children (control group). All the children were subjected to full history-taking, complete physical examination, measurement of peak expiratory flow rate (PEFR), chest x-ray, electrocardiography (ECG), echocardiographic examination, and both conventional and tissue Doppler study. The results of the tissue Doppler study examining the right ventricular diastolic function showed that peak E′ velocity (10.08 ± 2.8 cm/s), peak A′ velocity (5.7 ± 2.5 cm/s), E′/A′ ratio (1.77 ± 0.58 m/s), and isovolumetric relaxation time (IVRT) of the lateral tricuspid annulus (138.9 ± 30.7 m/s) among the asthmatic patients differed significantly from those among the control subjects (12.4 ± 2.3, 7.8 ± 2.1 cm/s; 1.58 ± 0.32, and 91.1 ± 32.6 m/s, respectively). In addition, the E′ velocity and IVRT of the lateral tricuspid annulus were significantly different among the mild, moderate, and severe cases (P < 0.001). It is concluded that although the clinical and conventional echocardiographic findings of the asthmatic children were apparently normal, the tissue Doppler echocardiographic study showed right ventricular dysfunction that is positively correlated with the severity of asthma. These findings signify the diagnostic value of tissue Doppler echocardiography for the early detection and monitoring of such deleterious effects among asthmatic patients.
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References
American Lung Association (2005) Trends in asthma morbidity and mortality: report from National Health Interview Survey, National Center for Health Statistics, USA. http://www.lungusa.org/atf/cf/7A8D42C2-FCCA-4604-8ADE. Retrived May 2005
Annagur AS, Kendirli GM, Yilmaz DU et al (2007) Is there any relationship between asthma and asthma attack in children and atypical bacterial infections: Chlamydia pneumoniae, Mycoplasma pneumoniae, and helicobacter pylori. J Trop Pediatr 12:180–183
Berry G, Simpson J (1998) Modeling strategy. In: Kerr CH, Taylor R, Heard G (eds) Handbook of public health methods, 1st edn. McGraw-Hill Book Cook Co, Roseville, pp 321–330
Cheung MM, Smallhorn JF, Redington AN, Vogel M (2004) The effects of changes in loading conditions and modulation of inotropic state on the myocardial performance index: comparison with conductance catheter measurements. Eur Heart J 25:2238–2242
Coghlan JG, Davar J (2007) How should we assess right ventricular function in 2008? Eur Heart J 9:H22–H28
Davenport PW, Waurice CT, Arlene AS, Yemiserach FG (2000) Respiratory-related evoked potentials in children with life-threatening asthma. Am J Respir Crit Care Med 161:1830–1835
Elmasry OA, Attia HM, Abdelfattah NM (2008) Assessment of left ventricular diastolic function in bronchial asthma: can we rely on transmitral inflow velocity patterns? Eur J Echocardiogr 7:178–190
Garcia MJ, Rodriguez L, Ares M et al (1996) Differentiation of constrictive pericarditis from restrictive cardiomyopathy: assessment of left ventricular diastolic velocities in longitudinal axis by Doppler tissue imaging. J Am Coll Cardiol 27:108–114
Garson JR, Bricker JT, Fisher DJ (2006) The science and practice of pediatric cardiology. In: Geva T et al (eds) Echocardiography, 2nd edn. Williams and Wilkins, Baltimore, pp 375–788
Hanno HL, Rainer AB, Michal EN et al (2006) Brain natriuretic peptide is a prognostic parameter in chronic lung disease. Am J Respir Crit Care Med 173:744–750
Hill M, Szefler SJ, Larsen GL (1992) Asthma pathogenesis and the implications for therapy in children. Pediatr Clin North Am 39:1205–1224
Ho CY, Solomon SD (2006) A clinician guide to tissue Doppler imaging. Circulation 113:e396–e398
MacNee W (1994) Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease and bronchial asthma. Am J Respir Crit Care Med 150:833–852
Mann DL (1996) The effect of tumor necrosis factor-alpha on cardiac structure and function: a tale of two cytokines. J Card Fail 2:S165–S172
Mannaerts HF, Balk AH, Simoons ML et al (1992) Changes in left ventricular function and wall thickness in heart transplant recipients and their relation to acute rejection: an assessment by digitized M mode echocardiography. Br Heart J 68:356–364
Masoli M, Fabian D, Holt S et al (2007) Global Initiative for Asthma (GINA) program: the global burden of asthma: executive summary of the GINA dissemination committee report. Allergy 62:469–478
Massoud MN, El-Nawawy AA, Abou El-Nazar SY et al (2000) Tumour necrosis factor-alpha concentration in severely asthmatic children. East Mediterr Health J 6:432–436
MeiLan KH, Vallerie VM, Gerard JC, Fernando JM (2007) Pulmonary diseases and the heart. Circulation 116:2992–3005
Mehta SK, Holliday C, Hayduk L et al (2004) Comparison of myocardial function in children with body mass indexes ≥25 versus those <25 kg/m2. Am J Cardiol 93:1567–1569
Miyatake K, Yamagishi M, Tanaka N et al (1995) A new method for the evaluation of left ventricular wall motion by color-coded tissue Doppler imaging: in vitro and in vivo studies. J Am Coll Cardiol 25:717–724
Nagueh SF, Middleton KJ, Kopelen HA et al (1997) Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 30:1527–1533
National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program (1997) Expert panel report 2: guidelines for the diagnosis and management of asthma. NIH Publication, Baltimore.
Nathaniel MH, Mark CP, Pardeep SJ et al (2009) Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Failure 11:130–139
Palka P, Lange A, Fleming AD et al (1996) Age-related transmural peak mean velocities and peak velocity gradients by Doppler myocardial imaging in normal subjects. Eur Heart J 17:940–950
Panidis IP, Ren JF, Holsclaw DS et al (1985) Cardiac function in patients with cystic fibrosis: evaluation by two-dimensional and Doppler echocardiography. J Am Coll Cardiol 6:701–706
Sagher FA, Roushdy MA, Hweta AM (1995) Peak expiratory flow rate nomogram in Libyan school children. East Mediterr Health J 5:560–564
Sahn DJ, DeMaria A, Kisslo J et al (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 58:1072–1083
Snider AR, Serwer GA, Ritter SP (1997) Echocardiography in pediatric heart disease, 2nd edn. Mosby, St. Louis, pp 195–223
Sutherland GR, Lange A, Palka P et al (1996) Does Doppler myocardial imaging give new insights or simply old information revisited (editorial). Heart 76:197–199
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Shedeed, S.A. Right Ventricular Function in Children with Bronchial Asthma: A Tissue Doppler Echocardiographic Study. Pediatr Cardiol 31, 1008–1015 (2010). https://doi.org/10.1007/s00246-010-9753-2
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DOI: https://doi.org/10.1007/s00246-010-9753-2